Departments of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan; Yu Neurosurgery Clinic, Toyonaka, Osaka 560-0083, Japan.
Departments of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
J Clin Neurosci. 2020 Mar;73:101-107. doi: 10.1016/j.jocn.2020.01.020. Epub 2020 Feb 13.
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the intractable long-term side effects of anticancer medications and results in pain and dysesthesia. Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex has been demonstrated to provide effective relief for intractable neuropathic pain. The objective of this study was to investigate the effects of rTMS treatment on CIPN in cancer patients.
Eleven female patients with breast cancer or gynecologic cancer (mean age 64.8 [standard deviation 7.8]) who had neuropathic pain and/or peripheral sensory neuropathy, with a minimum two grade severity based on the scale of the National Cancer Institutes' Common Terminology Criteria for Adverse Events (version 4.0) were enrolled. Patients received rTMS (5-Hz; 500 pulses/session; figure-8 coil) on their primary motor cortex corresponding to the target extremity. The intensity of pain and dysesthesia for all extremities was evaluated using a visual analog scale for pain, dysesthesia, and the Japanese version of the short-form McGill Pain Questionnaire 2 (SFMPQ2).
rTMS for target extremity significantly decreased the visual analog scale of pain and dysesthesia. The intensity of pain measured by the SFMPQ2 was also decreased in the target extremity. Regarding non-target extremities, only dysesthesia significantly decreased as a result of rTMS. No adverse events were observed.
This is an initial report demonstrating the potential of rTMS for the treatment of CIPN. We suggest rTMS could be potentially beneficial and effective as a treatment for pain and dysesthesia in patients with CIPN.
化疗引起的周围神经病变（CIPN）是抗癌药物的一种难治性长期副作用，会导致疼痛和感觉异常。初级运动皮层的重复经颅磁刺激（rTMS）已被证明可有效缓解难治性神经性疼痛。本研究旨在探讨 rTMS 治疗对癌症患者 CIPN 的影响。
11 名女性乳腺癌或妇科癌症患者（平均年龄 64.8[标准差 7.8]）纳入本研究，这些患者有神经病理性疼痛和/或周围感觉神经病变，根据国立癌症研究所不良事件通用术语标准（第 4.0 版）的最低 2 级严重程度进行评估。患者接受初级运动皮层对应目标肢体的 rTMS（5Hz；500 脉冲/次；8 字形线圈）。使用疼痛、感觉异常和日本短格式 McGill 疼痛问卷 2（SFMPQ2）的视觉模拟量表评估所有肢体的疼痛和感觉异常程度。
目标肢体的 rTMS 显著降低了疼痛和感觉异常的视觉模拟量表评分。SFMPQ2 测量的目标肢体的疼痛强度也降低了。对于非目标肢体，仅感觉异常因 rTMS 而显著降低。未观察到不良事件。
这是一项初步报告，证明 rTMS 治疗 CIPN 的潜力。我们建议 rTMS 可能作为 CIPN 患者疼痛和感觉异常的治疗方法具有潜在的益处和有效性。
